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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5497
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
FOR USE OF OFFICIALS SEARCHING IMMI-
NATURALIZATION SERVICE
GRATION RECORDS
CLERK OF COURT:
RECORDS EXAMINED
Place number
in
CARD INDEX
upper left-hand corner of all copies of
declaration, immediately under your
INDEX BOOKS
declaration number.
DISTRICT DIRECTOR OF NATURALIZATION.
MANIFESTS
(NOTE TO CLERK OF COURT.- To guide you in preparing the Declaration: The black face lines on this form contain statements
in the regular order as they are to appear on the Declaration of Intention.)
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
LOUIS LEVITTE
age,
24
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
Also known as
LOVIS LEVINE - NAME to BEUSED
(If alien has used any other name in this country, that name should be shown here)
I used that name because
My father used it
The full name of the person shown on my steamship ticket was
Louis LEVITTE
My mother's maiden name was
HINDA DION
My maiden name was (if woman)
My present
occcupation is Public ancountant
My personal description is: Color, White ; complexion, medium ; height, 5 feet 5/4 inches;
weight, 135 pounds; color of hair, Wake-Black color of eyes, Benor
;
other visible distinctive marks: scarmiddle left folm of thin
I was born in
Kushovita,
Keif (Utumaniat Russia
(City or town)
(Country)
on the 12 day of may
, 1904
My present residence
is 73 Belpen At Nen Lndon Conn
post office address is New fandm Conn.
(Number and street)
(City or tour
(County)
(State)
My
The place where or in
I took the ship train which landed me the United States was Lictora februa
Russia
, on
august (Month (Day) N 1913 (Year)
The ticket which I to this country bought Twasta or Boslone Russia
on came was at
(City)
(Country)
The name or on
of the ship railroad which I came was (OVER) Cyar"
c14-8
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Document data
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- Core
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- Type
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Context sent to Scholar
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5497\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nCLERK OF COURT:\nRECORDS EXAMINED\nPlace number\nin\nCARD INDEX\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\n(NOTE TO CLERK OF COURT.- To guide you in preparing the Declaration: The black face lines on this form contain statements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nLOUIS LEVITTE\nage,\n24\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\nLOVIS LEVINE - NAME to BEUSED\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nMy father used it\nThe full name of the person shown on my steamship ticket was\nLouis LEVITTE\nMy mother's maiden name was\nHINDA DION\nMy maiden name was (if woman)\nMy present\nocccupation is Public ancountant\nMy personal description is: Color, White ; complexion, medium ; height, 5 feet 5/4 inches;\nweight, 135 pounds; color of hair, Wake-Black color of eyes, Benor\n;\nother visible distinctive marks: scarmiddle left folm of thin\nI was born in\nKushovita,\nKeif (Utumaniat Russia\n(City or town)\n(Country)\non the 12 day of may\n, 1904\nMy present residence\nis 73 Belpen At Nen Lndon Conn\npost office address is New fandm Conn.\n(Number and street)\n(City or tour\n(County)\n(State)\nMy\nThe place where or in\nI took the ship train which landed me the United States was Lictora februa\nRussia\n, on\naugust (Month (Day) N 1913 (Year)\nThe ticket which I to this country bought Twasta or Boslone Russia\non came was at\n(City)\n(Country)\nThe name or on\nof the ship railroad which I came was (OVER) Cyar\"\nc14-8"
}